MEDICARE: WEATHERWAX FAMILY PHARMACIES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	5301004802	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2344884	OTHER		OTHER ID NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457469827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEATHERWAX FAMILY PHARMACIES INC

Provider Business Mailing Address
First Line	:	105 N MAIN ST
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8979
Country	:	US
Telephone Number	:	517-592-8505
Fax Number	:	517-592-4043

Provider Business Practice Location Address
First Line	:	105 N MAIN ST
Second Line	:
City	:	BROOKLYN
State	:	MI
Zip	:	49230-8979
Country	:	US
Telephone Number	:	517-592-8505
Fax Number	:	517-592-4043

Authorized Official
Title or Position	:	CHIEF PHARMACIST
Name	:	STEVEN WEATHERWAX
Credential	:
Telephone Number	:	517-592-8505

Provider Enumeration Date	:	08/27/2006
Last Update Date	:	05/16/2016

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